Provider Demographics
NPI:1093112641
Name:SUMA, SUSAN DAWN (OTR/L)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:DAWN
Last Name:SUMA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9601 JOHN WERNER DR
Mailing Address - Street 2:
Mailing Address - City:CHEBOYGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49721-9411
Mailing Address - Country:US
Mailing Address - Phone:810-683-4612
Mailing Address - Fax:
Practice Address - Street 1:9601 JOHN WERNER DR
Practice Address - Street 2:
Practice Address - City:CHEBOYGAN
Practice Address - State:MI
Practice Address - Zip Code:49721-9411
Practice Address - Country:US
Practice Address - Phone:810-683-4612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-25
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201008919225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist